Patient conditional diagnosis assessment and symptom tracking system

ABSTRACT

A system and method for conditionally diagnosing, assessing and tracking the symptoms of patients having mental or physical disorders involves providing an interview instrument having diagnostic and assessment information for a selected disorder. A clinician conducts a first interview of a patient to identify and assess the patient&#39;s symptoms. The clinician records the symptoms and assessment on the interview instrument. Alternatively, the patient records symptoms on the interview instrument and the clinician then conducts a first interview. The clinician develops a diagnosis and treatment plan and records them on the instrument. The clinician conducts one or more subsequent interviews of the patient for identifying and assessing the patient&#39;s symptoms and records any changes in the symptoms on the interview instrument for documenting the effects of the treatment plan. The interview instrument includes a joint use portion having a list of symptoms and assessment criteria and spaces for recording the patient&#39;s symptoms and an assessment, a diagnostic portion having predetermined, recognized diagnostic criteria for use by the clinician, a patient-use portion having educational information for use by the patient and a follow-up portion for tracking the effects of a treatment plan across multiple subsequent visits.

[0001] A portion of the disclosure of this patent document containsmaterial which is subject to copyright protection. The copyright ownerhas no objection to the facsimile reproduction by anyone of the patentdocument or the patent disclosure, as it appears in the Patent andTrademark Office patent file or records, but otherwise reserves allcopyright rights whatsoever.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention

[0003] The present invention is broadly concerned with a system andmethod for conditional diagnosis, assessment and symptom tracking ofpatients having behavioral health and/or physical disorders. Moreparticularly, it is concerned with a system and method for providing ahealth care practitioner with diagnostic criteria and assessmenttechniques for a particular disorder, recording a treatment plan, andtracking patient symptoms and responses to the treatment plan in orderto assess, optimize and document symptom improvement under the treatmentplan, as well as providing the patient and clinician with an educationand interaction tool for facilitating communication between patient andpractitioner regarding the nature of the disorder and purpose andprogress of the treatment.

[0004] 2. Description of the Related Art

[0005] Health care practitioners or clinicians voluntarily documentobservation and treatment of their patients so that they can monitortheir treatment plans and make appropriate revisions to optimize patientsymptom improvement. Such documentation is also required so that thequality of their care can be monitored by federal and state agencies,such as Medicare and Medicaid, and various private accreditationagencies, such as the Joint Committee on the Accreditation of HealthCare Organizations. Clinicians also need to maintain adequatedocumentation in order to respond to requests from third party insurersfor substantiation of patient claims for reimbursement.

[0006] Health care practitioners are trained to identify the symptoms ofa patient, make a diagnosis of a disorder or disease, assess theseverity of the disorder, develop a plan for treatment of the patientand track the progress of the treatment plan. To assist them indocumenting these steps, clinicians generally dictate their notes ofeach patient visit. The notes are subsequently transcribed andmaintained in a confidential record, or so-called “chart”. While theprimary purpose of the chart is to assist the clinician with diagnosisand assessment of the patient's progress under the treatment plan, italso serves an important documentation function. Although the patientgenerally does not have access to the chart, information may be culledfrom it and provided to third parties such as insurance companies andvarious regulatory and accreditation agencies. Each of such thirdparties has its own documentary requirements, and any failure of theclinician to fully meet such requirements may result in negativeconsequences for both the clinician and the patient. For example, thirdparty payors such as insurance companies frequently deny claims forreimbursement based on inadequate documentation of symptoms to supportthe diagnosis or progress under the treatment plan. And reimbursementmay be denied for treatment which is expensive or long term in caseswhere progress cannot be demonstrated by familiar, objective methods,such as by laboratory testing.

[0007] In addition, such chart-type documentation methods produce aseries of “snap shot” records of the patient's symptoms at each officevisit. Over the course of treatment, the chart may become voluminous andtime consuming for clinician review.

[0008] When a patient suffers from an injury or illness, a record of thepatient's symptoms, diagnosis (whether the disorder exists), assessment(the severity of the condition once it is diagnosed) and the progress ofthe chosen treatment plan are relatively easy to document. However, whena patient suffers form physical symptoms having no observable underlyingcause, or suffers from a disorder having behavioral or psychologicalsymptoms, documentation of diagnosis, assessment and progress under thetreatment plan can be substantially more difficult. Practitionersthemselves may have difficulty tracking the effectiveness of treatmentof such a patient.

[0009] In order to assist clinicians, various professional associationshave developed criteria for use in establishing a diagnosis, conductingan assessment and evaluating the effectiveness of a treatment planimplemented by the practitioner. For example, the American Psychiatricassociation has developed the DSM-IV Diagnostic Criteria for AttentionDeficit Hyperactivity Disorder (ADHD). A variety of diagnostic andassessment instruments have been implemented which employ such criteria.

[0010] Some instruments have been developed to assist in establishing adiagnosis, for example the Conners ADHD/DSM IV Scales. Some instruments,such as the Beck Depression Inventory, combine both diagnosis andassessment functions. Both of these types of instruments are generallyin the form of questionnaires, which may be completed by a patient or bya health care practitioner during an interview with the patient. Suchso-called self-reporting instruments include a set of predeterminedquestions which are answered by the patient. The responses may beforwarded to a testing center for visual or computerized scoring and theresults returned to the patient's health care practitioner forinterpretation. The responses may also be scored in the clinician'soffice. Alternatively, the health care practitioner may conduct astructured interview of the patient. As with self-reporting instruments,the patient's responses are scored and subsequently interpreted by thepractitioner.

[0011] Once a conditional diagnosis and assessment have been made, thehealth care practitioner generally develops a treatment programconsisting of prescribed medication and/or behavior management. Whetheror not the diagnosis and assessment are conducted simultaneously andwhether they are conducted by patient self-report or by structuredinterview, they provide a fixed record of the health status of thepatient at the time the diagnosis and assessment are made. Some healthcare practitioners provide their patients with copies of the diagnosisand assessment scores. However, without clinical knowledge andexperience, such scores generally provide a patient with little insight.

[0012] It is well known that the more targeted a treatment program is toa patient's own symptoms, the better the result. The effects of thetreatment program on the patient's symptoms and development of anyside-effects will determine whether the program requires modification.Thus, treatment is optimized by frequent periodic patient assessmentduring the course of the prescribed therapy. However, availableassessment instruments provide one time, “snap shot” views, which aretime consuming and require expensive subsequent scoring and analysis.Because they can only assess the patient's health status at the time ofadministration, they must be periodically readministered, scored andanalyzed throughout the duration of the treatment program. Even then,the resulting multiplicity of scored assessment instruments in thepatient's chart does not provide the clinician with a convenient,continuous summary of the patient's progress.

[0013] Some instruments, such as the Distressed Mood/BehaviorIntervention Form have been developed for use as preprinted charts forinstitutionalized patients. These instruments are used by caregivers todocument when a common behavioral symptom such as wandering occurs, theintervention, such as redirection, employed by the caregiver, and theinitials of the caregiver observing the behavior. While such instrumentsprovide a chart of patient behavior, they must be completed by thecaregiver and do not include diagnostic and assessment criteria for any,particular illness, or permit tracking of the patient's progress inresponse to a treatment program.

[0014] The diagnostic and assessment criteria for some disorders, suchas ADHD, are complex and the assessment depends heavily on the patient'srecollection. Consequently, a health care practitioner may havedifficulty obtaining a complete record of all reportable factors,including symptoms, settings and frequency at every office visit. Thecomplexity of the disorder may also leave patients confused and withunanswered questions about their disorder and their impairment mayprevent them from organizing their thoughts during the brief officevisit. Patients may also need general advice regarding alternativetreatment options and where they can obtain additional information; orthey may need more specific advice regarding how to keep track of theirsymptoms and communicate them to their health care practitioner so thatcomplete information is provided. While patient care pamphlets areavailable to provide general information regarding many commondisorders, they are not tailored to individual patients and they includeno patient-specific symptom information. Patients generally receivelittle written information regarding their particular disorder andtreatment plan and are provided with no written record of the initialassessment.

[0015] Accordingly, there is a need for a combination diagnostic andassessment tool that can be used as the basis for a dialog between apatient and practitioner during the office visit and which is aimed attracking the patient's symptoms and targeting the treatment for thosesymptoms as they change over time. Such a tool is needed in order todocument treatment progress for the clinician and the patient, as wellas for third parties such as insurers and regulatory agencies. There isalso a need for such a tool which is very easy to use in order to ensurethat it will be used at every office visit. Regular usage of such a toolis necessary in order to track the progress of the treatment program sothat the treatment can be promptly adjusted as necessary to optimize theoutcome.

SUMMARY OF THE INVENTION

[0016] The present invention relates generally to a method forconditionally diagnosing a mental or physical disorder in a patient andassessing and tracking the symptoms of the patient during treatment forthe disorder. The method involves providing an interview instrumenthaving a list of symptoms and diagnostic and assessment information fora selected disorder. A clinician conducts a first interview of thepatient to identify and assess the patient's symptoms of the disorder inaccordance with the list of symptoms and diagnostic and assessmentinformation. The clinician then records the patient's symptoms and theclinician's assessment of the symptoms on the interview instrument.Alternately, the patient records the patient's symptoms on the interviewinstrument and the clinician then conducts a first interview of thepatient. The clinician develops a diagnosis and treatment plan for thedisorder and records them on the interview instrument. The clinicianconducts one or more subsequent interviews of the patient foridentifying and assessing the patient's symptoms; and the clinicianrecords changes in the patient's symptoms on the interview instrumentfor documenting the effects of the treatment plan.

[0017] The interview instrument includes joint use, diagnostic,patient-use and follow-up portions. The joint-use portion includes alist of symptoms and assessment criteria and space for recording thepatient's symptoms as well an assessment of the symptoms. The diagnosticportion includes diagnostic information for a preselected disorder aswell as space for recording a treatment plan. The patient-use portionincludes instructions for communicating with the clinician andeducational information about the disorder. The follow-up portionincludes the listing of symptoms as well as spaces for recording changesin the patient's symptoms over time, under the treatment plan.

[0018] Objects and advantages of this invention will become apparentfrom the following description taken in conjunction with theaccompanying drawings wherein are set forth, by way of illustration andexample, certain embodiments of this invention.

[0019] The drawings constitute a part of this specification and includeexemplary embodiments of the present invention and illustrate variousobjects and features thereof.

BRIEF DESCRIPTION OF THE DRAWINGS

[0020]FIG. 1 is a plan view of a first side of a first page of a chartcopy of a patient assessment interview form for use in a patientconditional diagnosis and assessment tool in accordance with the presentinvention.

[0021]FIG. 2 is a plan view of a first side of a second page of a chartcopy of the patient assessment interview form shown in FIG. 1.

[0022]FIG. 3 is a plan view of a second side of the first page of thechart copy of a patient assessment interview form shown in FIG. 1including diagnostic criteria, Clarifying Information and AssessmentTechniques.

[0023]FIG. 4 is a plan view of a second side of the second page of thechart copy of a patient assessment interview form shown in FIG. 2,including continued Assessment Techniques and Strategies for AssessingChanges Due to Treatment

[0024]FIG. 5 is a plan view of a first side of a first page of a patientcopy of the patient assessment interview form similar to the form shownin FIG. 1.

[0025]FIG. 6 is a plan view of a first side of a second page of apatient copy of the patient assessment interview form shown in FIG. 5.

[0026]FIG. 7 is a plan view of a second side of the first page of apatient copy of the patient assessment interview form shown in FIG. 5,showing Patient Guidelines.

[0027]FIG. 8 is a plan view of a first side of an ADHD Follow-up Report.

[0028]FIG. 9 is a plan view of a second side of the Report shown in FIG.8.

[0029]FIG. 10 is a simplified flow diagram showing steps of a patientconditional diagnosis, assessment and symptom tracking system inaccordance with the invention.

[0030]FIG. 11 is a more detailed flow diagram showing steps of thesystem depicted in FIG. 10.

DETAILED DESCRIPTION OF THE INVENTION

[0031] As required, detailed embodiments of the present invention aredisclosed herein; however, it is to be understood that the disclosedembodiments are merely exemplary of the invention, which may be embodiedin various forms. Therefore, specific structural and functional detailsdisclosed herein are not to be interpreted as limiting, but merely as abasis for the claims and as a representative basis for teaching oneskilled in the art to variously employ the present invention invirtually any appropriately detailed structure.

[0032] Referring now to the drawings, FIGS. 10 and 11 depict a patientconditional diagnosis, assessment and symptom tracking method 10 inaccordance with the present invention. FIGS. 1-9 depict an exemplarypatient assessment interview instrument 12 for use in diagnosingpatients with Attention Deficit Hyperactivity Disorder (ADHD). Theinterview instrument 12 includes a joint-use portion 14 (FIGS. 1-2except spaces 78 and 80 and FIGS. 5-6), a diagnostic or clinician-useportion 16 (FIGS. 3-4 and boxes 78 and 80 of FIGS. 1-2), a patient-useportion 18 (FIG. 7), and a follow-up portion 20 (FIGS. 8-9).

[0033] Referring now to FIGS. 1-2 and 5-6, the joint-use portion 14 isdesigned for use by both the clinician and the patient. It includesidentifying information in the form of a patient name space 22, a parentname space 24, date space 26 and a patient information space 28 forrecording information relevant to diagnosis and treatment, such as age,grade, teacher, height, weight and blood pressure. It also includes alisting of the symptoms 30 with adjacent check boxes for recording thediagnostic environment or setting 32 and frequency assessment 34.Advantageously, the joint use portion 14 combines the information whichis needed for diagnosis into a single record which may be easilyreviewed by both the clinician and the patient. A space 36 is providedto enter examples of the symptoms, including the severity of theimpairment. The joint use portion 14 may be completed by the clinicianduring a structured interview , or it may be completed by the patient.The joint use portion 14 also includes title and pagination indicia 38.

[0034] The diagnostic or clinician-use portion 16 shown in FIGS. 3-4includes diagnostic and assessment information for a selected illness ordisorder for use by a clinician. The information in this portion 16 isprovided to educate and assist the clinician in reaching a conditionaldiagnosis and includes instructions 40 for using the interviewinstrument 12 to implement the tracking system and method 10. Diagnosticcriteria 42 are provided for a preselected disorder or illness,including a listing of specific symptoms 30, diagnostic clarifyinginformation 44 for use by the clinician in evaluating the symptoms 30,assessment techniques 46 for use by the clinician in assessing thesymptoms 30, impairment and treatment response strategies 48 forassessing changes attributable to treatment. The clinician-use portion16 also includes space for entry of Notes 50 and a Treatment Plan 52 bythe clinician. These spaces are blocked out on the joint use-portiondepicted in FIGS. 5 and 6, so that the Notes 50 and Treatment Plan 52entered into these spaces by the clinician will not be automaticallytransferred to the pages distributed to the patient.

[0035] The diagnostic criteria 42, such as “Symptoms must have persistedfor at least 6 months to a degree that is maladaptive and inconsistentwith developmental level,” and symptoms 30, such as “often hasdifficulty sustaining attention in tasks or play activities” may bederived from a diagnostic manual for psychiatric disorders, such as theDiagnostic and Statistical Manual of Mental Disorders (DSM) published bythe American Psychiatric Association, or from any other recognizedsource. In the case of physical illnesses or disorders, the diagnosticcriteria 42 may be derived from a medical diagnostic manual such as TheInternational Classification of Diseases (ICD), published by the WorldHealth Organization.

[0036] The diagnostic clarifying information 44, includes informationspecific to the preselected disorder necessary for evaluating thesymptoms 30 once they are identified. In the exemplary interviewinstrument 12 for ADHD, diagnostic clarifying information 44 includesinformation regarding age of onset of the disorder, number and severityof the symptoms, pervasiveness and persistence of the impairment andpersistence of the symptoms 30 designed to aid the clinician making aconditional differential diagnosis. Depending on the preselecteddisorder, the diagnostic clarifying information 44 may include any otherfactors recognized to be relevant to evaluation of the symptoms 30.

[0037] Although definitive diagnostic tests are available for somedisorders, others like ADHD can only be diagnosed following carefulassessment of the patient's history and symptoms 30. The interviewinstrument 12 includes assessment techniques 46 for assisting theclinician in assessing symptoms 30 of the preselected disorder,impairment of the patient attributable to the symptoms 30 and treatmentresponse. Assessment techniques 46 may include interview and historytechniques 54 designed to assist the clinician in gathering a completehistory necessary to differentiate between situational problems, otherdisorders and a preselected disorder, such as ADHD. Assessmenttechniques 46 may also include observation techniques 56 for observingthe patient's functioning in a plurality of environments, the family andpsychiatric history 58 and medical history 60, which may indicate alikelihood of developing the disorder, identify causal factors, orprovide other clues to diagnosis.

[0038] Strategies 48 for assessing changes attributable toimplementation of a treatment plan include establishing target symptoms62 and domains of impairment 64 and measuring changes at different drugdosages 62.

[0039] Although the term clinician is used herein for consistency, themethod 10 and assessment instrument 12 may also be used to good effectby any behavioral or medical practitioner, such as physicians,psychologists, counselors, social workers, speech pathologists,physician's assistants, nurse practitioners, as well as teachers andtherapists.

[0040] The patient use portion 18 of the instrument 12 is shown in FIG.7 to include instructions 68 for use of the interview instrument 12. Theinstructions 68 include directives to learn 70 about the disorder,communicate 72 with the clinician and use the interview instrument 12 totrack symptom improvement 74. Depending on the preselected disorder,additional directives may also be included. The patient use portion 18also includes a patient information section 76 including contactinformation for organizations that offer resources directed to thedisorder and a treatment section 78 that describes the acceptedtreatment approaches for the disorder. Pharmaceutical information 80appropriate to the disorder may also be included. The pharmaceuticalinformation 80 may include names of therapeutic agents approved for usein treatment of the disorder and information about dosage,administration, contraindications and warnings. The pharmaceuticalinformation 80 may be accompanied by advertising indicia 81 of one ormore selected pharmaceutical companies and the trade names of theirtherapeutic agents which may be suitable for use in treatment of thedisorder. While the pharmaceutical information 80 is preferably printedon the patient-use portion 18 to inform patients of availablepharmaceuticals for treating the disorder, this information may also beprinted on the clinician-use portion 16.

[0041] The follow up report 20 is depicted in FIGS. 8 and 9 to include aplurality of lists of the symptoms 30 of the disorder with adjacent datespaces 82 for entry of the date of each follow-up visit. Adjacent thesymptoms 30 are check boxes for No change 84, Improved/still needsattention 86 and Resolved 88. It is foreseen that, for some disorders, acheck box indicating regression (not shown) may also be provided. A notespace 90 is provided so that the clinician may indicate environmental,time, frequency or any other relevant differences in symptomimprovement, e.g. that the symptom 30 is more improved at school than athome or that the symptom 30 is more improved in the morning than laterin the day. The Follow-up report 20 includes lines for recording certainpatient information such as name 92, parent 94, patient's age 96, grade98, teacher 100 as well as a note space 102 for entry of any specificproblems or concerns of the clinician. Space is also provided forrecording physical characteristics such as a height space 104, weightspace 106, blood pressure space 108 for recording blood pressure as wellas any blood chemistry, such as, for example, serotonin levels, whichmay be relevant to tracking drug therapy. A medication information space112 is provided for recording medication information relevant to thedisorder, such as whether the medication is continued over weekends andduring the summer. A listing of relevant medication side effects withadjacent check boxes 114 is also provided. The follow-up report 20 alsoincludes space 116 for clinician notes/treatment changes, such asadjustment of medication dosage, recommendations for additional therapysuch as behavioral therapy and any other treatment recommendations. Thefollow-up report 20 thus provides a concise record over time of thepatient's progress under the treatment plan. The follow-up report 20 isdesigned primarily for review by the clinician in evaluating thepatient's progress. However, it may also be distributed to the patient,so that the patient can review the progress and use this information tobetter communicate changes in their symptoms 30 to the clinician.

[0042] While the exemplary interview instrument 12 addresses twovariants of a disorder which frequently occur in combination, AttentionDeficit Disorder with or without Hyperactivity, it may also be designedto address other disorders, either singly or in groups of two or more.It may be employed for treatment of patients having some symptoms of anyof a number of mental or physical disorders or illnesses, such asanxiety, dementia, disorders of the central nervous system, eatingdisorders, elimination disorders such as enuresis and encopresis,headaches and migraines, mood disorders such as Bipolar Disorder andDepression, psychoses such as Schizophrenia, sleep disorders, substanceabuse, and chronic conditions such as Diabetes and Asthma. Those skilledin the art will appreciate that the system of the present invention canbe employed for virtually any conditionally diagnosable mental orphysical illness or disorder or combination thereof.

[0043] The interview instrument 12 may be implemented as either aprinted booklet of tear-sheets or as a computer program generating avideo display. FIGS. 1-9 depict the respective pages or screen displays.In booklet form, the exemplary ADHD interview instrument 12 includes twopairs of stacked pages and a third page for the follow-up portion 20.The pages are constructed so that FIGS. 1 and 3 depict respective firstand second sides of a first page to be retained by a clinician and FIGS.2 and 4 depict respective first and second sides of a second page to beretained by the clinician. In similar fashion, FIGS. 5 and 7 coverrespective first and second sides of a first page to be retained by apatient and FIGS. 6 and 7 cover respective first and second sides of asecond page to be retained by the patient. FIGS. 8 and 9 coverrespective first and second sides of a follow-up report 20 to beretained by the clinician as documentation of the progress of thepatient. In this manner, the educational material depicted in FIGS. 3and 4 is imprinted on the reverse sides of the pages to be retained bythe clinician and the educational material depicted in FIG. 7 isimprinted on the reverse side of the pages to be distributed to thepatient. Where the patient educational material can be fitted onto asingle page, as is shown in FIG. 7, then it may be imprinted on thereverse side of each page to be retained by the patient. It is alsoforeseen that the reverse side of one of the pages could be left blank,or lines for patient notes. Depending upon the length of the joint-useportion 14 and the length of the clinician-use and patient-useeducational portions, it may not always be feasible to print therespective clinician and patient education portions on the reverse ofthe clinician-use 16 or patient-use 18 portions. In such instances,additional pages may be required or the information may be edited forlength.

[0044] A first Page 1 depicted in FIG. 1 is stacked atop a second Page 1depicted in FIG. 5. A first page 2 is depicted in FIG. 2 and is stackedatop a second page 2 depicted in FIG. 6. The pages are constructed ofso-called “carbonless” paper, so that entries on the first page 1depicted in FIG. 1 in the setting and frequency check boxes 32 and 34and notations in the space 36 for description of symptoms and examplesare automatically transferred into the corresponding spaces on thesecond page 1 depicted in FIG. 5. Similarly, entries on the first page 2depicted in FIG. 2 will be automatically transferred into thecorresponding spaces on the second page 2 depicted in FIG. 6.

[0045] All of the pages of the interview instrument 12 are ofapproximately the same size, which may be any suitable size, such as,for example about 8 ½ inches by about 11 inches, except that the pairsof first and second pages and the follow-up report 20 may beprogressively offset from each other by a short distance and imprintedwith a title and/or pagination indicia, in the manner of an index. Thisarrangement serves to facilitate tear-sheet type removal of the copiesof pages 1 and 2 by the clinician for distribution to the patient.

[0046] The symptoms 30 are arranged on the page fronts with adjacentboxes for indicating the environments described in the diagnosticcriteria 42 and assessment techniques 46. The diagnostic criteria 42 andsymptoms 30 are elucidated on the reverse side of the pages.

[0047] The previously described interview instrument 12, as shown inFIGS. 1-9 is adapted for use in a diagnosis, assessment and symptomtracking system or method 10. FIG. 10 is a flow diagram with blocksrepresenting the following steps of a simplified embodiment of themethod 10: providing the clinician with an interview instrument, block118; conducting an initial patient interview and assessment, block 122;recording symptoms on the interview instrument, block 124; developing adiagnosis and treatment plan and recording the plan on the interviewinstrument, block 126; implementing the treatment plan, block 128;conducting a follow-up patient interview and assessment, block 133;recording changes in symptoms on the interview instrument, block 136;reviewing the interview instrument to track progress of the patientunder the treatment plan, block 138; modifying the treatment plan, block140; and, alternatively, continuing the treatment plan, block 142 ordiscontinuing the treatment, block 144. As previously discussed,recording symptoms on the interview instrument, block 124 may beundertaken by the patient, and in such cases precedes conducting aninitial patient interview and assessment, block 122.

[0048] In more detail, as shown in FIGS. 10 and 11, block 118corresponds to providing the clinician with an interview instrumentspecially designed for diagnosis of a selected disorder and previouslydescribed in detail in association with reference numeral 12. Theinterview instrument 12 includes a joint use portion 14 for use by boththe clinician and the patient, a diagnostic portion 16 for use by theclinician, a patient-use portion 18 for use by the patient, and afollow-up portion 20 for use by the clinician. While it is useful toorganize the interview instrument 12 in this manner, such usagedesignations are not hard and fast. Any portion of the instrument may beconsidered to be a joint-use portion 14 where joint use may enhance theinteractive nature of the interview and assessment or is likely toimprove the treatment outcome.

[0049] The diagnostic portion 16 of the instrument 12 includesinstructions 40, a list of symptoms 30 and diagnostic and assessmenteducational information about the disorder for clinician reference. Thediagnostic and assessment information includes diagnostic criteria 42,diagnostic clarifying information 44 and assessment techniques 46.

[0050] The clinician consults the diagnostic and assessment informationcontained on the interview instrument, block 120 and conducts theinitial interview and assessment, block 122 in accordance with the listof symptoms 30 and the diagnostic and assessment information containedin the interview instrument 12. The clinician next records the symptoms30, the environment 32 in which they occur and the clinician'sassessment of the patient's symptoms on the joint-use portion of theinterview instrument, block 124. In some instances, it may be desirableto employ the space 36 for recording the exact words used by the patientto describe the symptoms. It is also foreseen that the patient mayparticipate in this step by recording the symptoms, block 124. It isalso foreseen that the instrument 12 may be implemented as a computerprogram, generating a screen display, which may be accessed and used byeither or both of the clinician and the patient to record the symptoms30. In such instances, the clinician may consult the record of thesymptoms 30 prior to conducting the initial patient interview andassessment, block 122.

[0051] The clinician next identifies target symptoms for treatment anddevelops a treatment plan for treatment of the disorder and records thetreatment plan on the interview instrument, block 126. The clinician mayrefer to the recorded symptoms 30, environment 32, frequency 34 and anyseverity information recorded on the interview instrument 12 in order toidentify the target symptoms. The treatment plan may include medicalprocedures such as surgery, physical or behavioral therapy,administration of therapeutic agents as well as periodic testing, suchas blood chemistry, ECG, blood pressure, or any other suitabletreatment. The treatment plan is implemented, block 128 and in someinstances the interview instrument may be reviewed by a third party,block 130. Third party review may be conducted by private or publicinsurers, such as Medicare and Medicaid, in order to determine whetherand to what extent charges incurred by the patient for the interview andsubsequent treatment will be reimbursable, or it may be conducted bystate or federal regulatory agencies charged with reviewing quality ofpatient care.

[0052] The clinician distributes both the joint-use 14 and patient-use18 portions of the instrument 12 to the patient. The patient use portion18 includes instructions 68, patient educational information about thedisorder 76 and a summary of treatment options 78. The patient nextreviews at step 132 the patient information and the recorded symptoms 30on the interview instrument 12. Such patient review enhancescommunication between the clinician and the patient.

[0053] At step 134 the clinician reviews the interview instrument 12 andconducts an interactive follow-up interview of the patient includingassessment of the symptoms. Educated by review of the patientinformation and recorded symptoms on the interview instrument in block132, the patient is better equipped to identify symptoms of the disorderas they are experienced as well as their environment and frequency. Thisimproves the accuracy of the information garnered during the interviewprocess and the communication of the information to the clinician forrecording on the interview instrument 12. It also improves the qualityof the patient's choices regarding treatment options and the patient'sparticipation in the treatment itself.

[0054] The clinician next records at step 136 any changes in thepatient's symptoms on the follow-up report portion 20 of the interviewinstrument 12. The clinician reviews the interview instrument to 12track the progress of the patient under the treatment plan at step 138.This review may cause the clinician to determine that the treatment planis appropriate and should be continued, blocks 140, 142 and 128, thatthe treatment plan has been accomplished and can be discontinued, blocks140, 142 and 144, or that the treatment plan should be modified, blocks140, 128.

[0055] In this manner, the interview instrument 12 functions as a dialogtool between the patient and clinician for improving diagnosis andassessment of a disorder or illness across multiple patient care visits.The follow-up report portion 20 of the interview instrument 12 providesdocumentation of the patient's progress across multiple visits. Thefollow-up report serves as a tracking tool for third parties who mayhave an interest in determining whether the patient is making progressunder the treatment plan as well as documentation.

[0056] It is to be understood that while certain forms of the presentinvention have been illustrated and described herein, it is not to belimited to the specific forms or arrangement of parts described andshown.

What is claimed and desired to be secured by Letters Patent is asfollows:
 1. A method for conditionally diagnosing a disorder in apatient and assessing and tracking the symptoms of the patient duringtreatment for the disorder, comprising the steps of: a. providing aninterview instrument including diagnostic and assessment information fora selected disorder and a follow-up portion; b. said clinicianconducting a first interview of said patient for identifying andassessing said patient's symptoms of said disorder in accordance withsaid list of symptoms and diagnostic and assessment information; c. saidclinician recording said patient's symptoms and said clinician'sassessment of said patient's symptoms on said interview instrument; d.said clinician developing a diagnosis and treatment plan for treatmentof said disorder and recording said treatment plan on said interviewinstrument; e. said clinician conducting a subsequent interview of saidpatient for assessing changes in said patient's symptoms of saiddisorder; and f. said clinician recording changes in said patient'ssymptoms on said follow-up portion of said interview instrument fortracking effects of said treatment plan.
 2. The method in claim 1,wherein said interview instrument further includes a patient informationportion.
 3. The method of claim 1 further including the step of: a. saidclinician identifying target symptoms of said patient for treatment. 4.The method in claim 1 including the steps of: a. said cliniciandistributing a copy of said recorded symptoms, said assessment and saidpatient information to said patient; and b. said patient reviewing saidcopy and said patient information for learning about said disorder andbetter communicating with said clinician.
 5. The method as set forth inclaim 1 wherein said patient records said patient's symptoms on saidinterview instrument before said clinician conducts said firstinterview.
 6. The method as set forth in claim 1 wherein the step ofrecording said patient's symptoms and said clinician's assessment ofsaid patient's symptoms on said interview instrument further includesthe step of: a. said clinician recording the words used by said patientto describe said symptoms.
 7. A method for conditionally diagnosing adisorder in a patient and assessing and tracking the symptoms of thepatient, comprising the steps of: a. providing an interview instrument;said interview instrument including a diagnostic portion for use by saidclinician, a patient-use portion for use by said patient, a joint-useportion for use by both said clinician and said patient, and a follow-upportion for use by said clinician; said diagnostic portion of saidinterview instrument including symptom, diagnosis and assessmentinformation for a selected disorder; said patient-use portion of saidinterview instrument including educational information about saiddisorder; b. said clinician reviewing said diagnostic and assessmentinformation, interviewing said patient, recording said symptoms on saidjoint-use portion of said interview instrument to create a record ofsymptoms, and identifying target symptoms for treatment; c. said patientreviewing said educational information on said patient-use portion ofsaid interview instrument and reviewing said record of said symptoms;and d. said clinician again interviewing said patient, said patientreporting changes in said symptoms, and said clinician recording saidchanges in symptoms on said follow-up portion of said interviewinstrument for documenting the effects of said treatment.
 8. The methodas set forth in claim 7 further including the steps of: a. saidclinician distributing said joint-use portion of said interviewinstrument to said patient; b. said patient receiving said joint-useportion of said interview instrument and reviewing said symptoms andsaid environment.
 9. The method as set forth in claim 7 wherein saidpatient records said patient's symptoms and the environment in whichsaid symptoms occur on said joint-use portion of said interviewinstrument.
 10. The method as set forth in claim 7 wherein the step ofinterviewing said patient and recording effects of said treatment onsaid patient's symptoms on said follow-up portion of said interviewinstrument is repeated.
 11. The method as set forth in claim 7 furtherincluding the step of: a. said clinician recording medication sideeffects on said patient.
 12. The method as set forth in claim 7 furtherincluding the step of: a. said clinician recording additional patientinformation.
 13. The method as set forth in claim 7 further includingthe step of: a. submitting said joint use and said clinician-usediagnostic portions of said interview instrument to a health careinsurer as documentation for reimbursement for providing care to saidpatient.
 14. The method as set forth in claim 7, further including thestep of: a. submitting said follow-up portion of said interviewinstrument to said health care insurer as documentation forreimbursement for providing continuing care to said patient.
 15. Amethod of promoting usage of a therapeutic agent, including the stepsof: a. providing an interview instrument including a list of symptomsand diagnostic and assessment information for a selected disorder; b.printing advertising indicia for a predetermined therapeutic agent onsaid interview instrument; c. said clinician conducting an interview ofsaid patient and recording said patient's symptoms on said interviewinstrument; d. said clinician analyzing said symptoms and developing atreatment plan for treatment of said disorder and recording saidtreatment plan on said interview instrument; and e. upon said treatmentplan calling for a therapeutic agent such as said predeterminedtherapeutic agent, said clinician prescribing said predeterminedtherapeutic agent to said patient.
 16. An interactive interviewinstrument for conditionally diagnosing a disorder in a patient andassessing and tracking the symptoms of the patient during treatment by aclinician for the disorder, comprising: a. a diagnostic portion for useby said clinician, said portion including diagnostic information for aselected disorder and space for recording a treatment plan; b. apatient-use portion for use by said patient, said portion includinginstructions for communicating with said clinician and educationalinformation about said disorder; c. a joint-use portion for use by bothsaid clinician and said patient, said portion including a list ofsymptoms and assessment criteria and space for recording said patient'ssymptoms and said clinician's assessment of said patient's symptoms; d.a follow-up portion for use by said clinician, said portion includingsaid listing of symptoms and a plurality of spaces for recording changesin symptoms of said patient over time under said treatment plan.
 17. Theinteractive interview instrument in claim 16, said diagnosticinformation further including: a. symptom information; and b. assessmentinformation for a selected disorder.
 18. The interactive interviewinstrument in claim 16, said diagnostic information further including:a. diagnostic criteria for diagnosing said disorder; b. diagnosticclarifying information for evaluating said symptoms; and c. assessmenttechniques for assessing changes attributable to said treatment plan.19. The interactive interview instrument in claim 16, said diagnosticportion further including: a. pharmaceutical information.
 20. Theinteractive interview instrument in claim 16, said diagnostic portionfurther including: a. space for recording additional patientinformation.
 21. The interactive interview instrument in claim 16, saidjoint-use portion further including: a. space for recording settings inwhich said patient may experience each of said symptoms; and b. spacefor recording frequency of each of said symptoms.
 22. The interactiveinterview instrument in claim 16, said follow-up portion furtherincluding: a. space for recording medication effects experienced by saidpatient.
 23. An interview instrument for conditionally diagnosing adisorder in a patient and assessing and tracking the symptoms of thepatient during treatment; comprising a. a diagnostic portion includingdiagnostic criteria for a selected disorder; b. space for a clinician torecord symptoms of said patient and a treatment plan; b. a follow-upportion, said portion including a listing of symptoms and a plurality ofspaces for recording changes in symptoms of said patient over time undersaid treatment plan.
 24. The interview instrument in claim 23, whereinsaid diagnostic portion further includes: a. diagnostic criteria fordiagnosing said disorder; and b. assessment techniques for assessingchanges attributable to said treatment plan.